Cargando…
Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis
BACKGROUND: Countries with high TB burden have expanded access to molecular diagnostic tests. However, their impact on reducing delays in TB diagnosis and treatment has not been assessed. Our primary aim was to summarize the quantitative evidence on the impact of nucleic acid amplification tests (NA...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748908/ https://www.ncbi.nlm.nih.gov/pubmed/36517736 http://dx.doi.org/10.1186/s12879-022-07855-9 |
_version_ | 1784849929030598656 |
---|---|
author | Lee, Jae Hyoung Garg, Tushar Lee, Jungsil McGrath, Sean Rosman, Lori Schumacher, Samuel G. Benedetti, Andrea Qin, Zhi Zhen Gore, Genevieve Pai, Madhukar Sohn, Hojoon |
author_facet | Lee, Jae Hyoung Garg, Tushar Lee, Jungsil McGrath, Sean Rosman, Lori Schumacher, Samuel G. Benedetti, Andrea Qin, Zhi Zhen Gore, Genevieve Pai, Madhukar Sohn, Hojoon |
author_sort | Lee, Jae Hyoung |
collection | PubMed |
description | BACKGROUND: Countries with high TB burden have expanded access to molecular diagnostic tests. However, their impact on reducing delays in TB diagnosis and treatment has not been assessed. Our primary aim was to summarize the quantitative evidence on the impact of nucleic acid amplification tests (NAAT) on diagnostic and treatment delays compared to that of the standard of care for drug-sensitive and drug-resistant tuberculosis (DS-TB and DR-TB). METHODS: We searched MEDLINE, EMBASE, Web of Science, and the Global Health databases (from their inception to October 12, 2020) and extracted time delay data for each test. We then analysed the diagnostic and treatment initiation delay separately for DS-TB and DR-TB by comparing smear vs Xpert for DS-TB and culture drug sensitivity testing (DST) vs line probe assay (LPA) for DR-TB. We conducted random effects meta-analyses of differences of the medians to quantify the difference in diagnostic and treatment initiation delay, and we investigated heterogeneity in effect estimates based on the period the test was used in, empiric treatment rate, HIV prevalence, healthcare level, and study design. We also evaluated methodological differences in assessing time delays. RESULTS: A total of 45 studies were included in this review (DS = 26; DR = 20). We found considerable heterogeneity in the definition and reporting of time delays across the studies. For DS-TB, the use of Xpert reduced diagnostic delay by 1.79 days (95% CI − 0.27 to 3.85) and treatment initiation delay by 2.55 days (95% CI 0.54–4.56) in comparison to sputum microscopy. For DR-TB, use of LPAs reduced diagnostic delay by 40.09 days (95% CI 26.82–53.37) and treatment initiation delay by 45.32 days (95% CI 30.27–60.37) in comparison to any culture DST methods. CONCLUSIONS: Our findings indicate that the use of World Health Organization recommended diagnostics for TB reduced delays in diagnosing and initiating TB treatment. Future studies evaluating performance and impact of diagnostics should consider reporting time delay estimates based on the standardized reporting framework. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07855-9. |
format | Online Article Text |
id | pubmed-9748908 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-97489082022-12-14 Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis Lee, Jae Hyoung Garg, Tushar Lee, Jungsil McGrath, Sean Rosman, Lori Schumacher, Samuel G. Benedetti, Andrea Qin, Zhi Zhen Gore, Genevieve Pai, Madhukar Sohn, Hojoon BMC Infect Dis Research BACKGROUND: Countries with high TB burden have expanded access to molecular diagnostic tests. However, their impact on reducing delays in TB diagnosis and treatment has not been assessed. Our primary aim was to summarize the quantitative evidence on the impact of nucleic acid amplification tests (NAAT) on diagnostic and treatment delays compared to that of the standard of care for drug-sensitive and drug-resistant tuberculosis (DS-TB and DR-TB). METHODS: We searched MEDLINE, EMBASE, Web of Science, and the Global Health databases (from their inception to October 12, 2020) and extracted time delay data for each test. We then analysed the diagnostic and treatment initiation delay separately for DS-TB and DR-TB by comparing smear vs Xpert for DS-TB and culture drug sensitivity testing (DST) vs line probe assay (LPA) for DR-TB. We conducted random effects meta-analyses of differences of the medians to quantify the difference in diagnostic and treatment initiation delay, and we investigated heterogeneity in effect estimates based on the period the test was used in, empiric treatment rate, HIV prevalence, healthcare level, and study design. We also evaluated methodological differences in assessing time delays. RESULTS: A total of 45 studies were included in this review (DS = 26; DR = 20). We found considerable heterogeneity in the definition and reporting of time delays across the studies. For DS-TB, the use of Xpert reduced diagnostic delay by 1.79 days (95% CI − 0.27 to 3.85) and treatment initiation delay by 2.55 days (95% CI 0.54–4.56) in comparison to sputum microscopy. For DR-TB, use of LPAs reduced diagnostic delay by 40.09 days (95% CI 26.82–53.37) and treatment initiation delay by 45.32 days (95% CI 30.27–60.37) in comparison to any culture DST methods. CONCLUSIONS: Our findings indicate that the use of World Health Organization recommended diagnostics for TB reduced delays in diagnosing and initiating TB treatment. Future studies evaluating performance and impact of diagnostics should consider reporting time delay estimates based on the standardized reporting framework. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07855-9. BioMed Central 2022-12-14 /pmc/articles/PMC9748908/ /pubmed/36517736 http://dx.doi.org/10.1186/s12879-022-07855-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Lee, Jae Hyoung Garg, Tushar Lee, Jungsil McGrath, Sean Rosman, Lori Schumacher, Samuel G. Benedetti, Andrea Qin, Zhi Zhen Gore, Genevieve Pai, Madhukar Sohn, Hojoon Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title | Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title_full | Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title_fullStr | Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title_full_unstemmed | Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title_short | Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
title_sort | impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748908/ https://www.ncbi.nlm.nih.gov/pubmed/36517736 http://dx.doi.org/10.1186/s12879-022-07855-9 |
work_keys_str_mv | AT leejaehyoung impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT gargtushar impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT leejungsil impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT mcgrathsean impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT rosmanlori impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT schumachersamuelg impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT benedettiandrea impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT qinzhizhen impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT goregenevieve impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT paimadhukar impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis AT sohnhojoon impactofmoleculardiagnostictestsondiagnosticandtreatmentdelaysintuberculosisasystematicreviewandmetaanalysis |